[The transition preparation consultation: What for?] / La consultation de préparation à la transition : pour quoi faire ?

The transition from pediatrics to adult services represents one of the many changes experienced by adolescents with chronic illnesses between childhood and adulthood. It needs to be structured and personalized to support the young person's development and empowerment, as well as the construction of his or her overall life project. With this in mind, AD'venir offers transition preparation consultations, the details and benefits of which are described in this article.

Are transition preparation consultations for adolescents with chronic conditions valuable? A mixed-methods study.

Our objective was to assess the value of transition preparation consultations (TPC) offered by the AD'venir unit (R. Debré hospital, Paris) as a new service of transitional care, from the perspective of adolescents with chronic conditions (CCs) and their referring healthcare providers (RHCPs). TPCs included a face-to-face interview with pediatricians trained in adolescent medicine, exploring the adolescent's past (CC history), present (daily life, Treatment Burden Questionnaire, family/peer relationships, school, hobbies, sexuality, drugs), and future (global life project, transition, Good2Go questionnaire). The mixed-methods design included the following: a qualitative analysis within a multidisciplinary group (clinicians/sociologists/psychologist/public health researchers) of audio-recordings of TPCs (n = 27/girls = 56%/median age = 17.7 years) and phone interviews with adolescents 2 years post-TPC (n = 26); and a quantitative analysis of the Treatment Burden and Good2Go questionnaires and the benefits perceived by RHCPs (questionnaire 6 months post-TPC). TPCs were a form of training for adult care, adolescents meeting a practitioner alone often for the first time. Naming their CC was difficult. All complained of limitations experienced in social life (diet, fatigue, laboratory/medical appointments), but not the treatment itself; most adolescents willingly talked about sexuality. Adolescents' feelings about transition were various, with poor representations of adult healthcare. Transfer was frequently unplanned. After TPCs, RHCPs modified their practices. Transition in the 2 years post-TPC was usually successful. Conclusion What is Known: • In adolescents with chronic conditions, it is advocated to personalize transition care according to the clinical and social context, pointed out as potentially impacting. • Little is known about the most effective ways to prepare patients according to their needs. What is New: • Based on a global approach to adolescent health, transition preparation consultations are delivered by specially trained physicians. • They are a feasible and valuable way to highlight facilitators and barriers to successful transition and initiate the adolescents' own vision of their future.

[Accompanying the pediatric/adult service transition in chronically ill patients]. / Accompagner la transition pédiatrie-service d'adultes dans la maladie chronique.

The transition is a key step for adolescents with chronic illnesses, as they are at risk of a disruption in care, complications and even mortality. Accompanying this process is based on two axes: autonomization of the young person (acquisition of knowledge and know-how in a perspective of empowerment) and structuring of the care pathway (transition measures, pediatric/adult service coordination).

Validation of the "Good2Go": the first French-language transition readiness questionnaire.

The use of transition readiness questionnaires is strongly recommended in adolescents with chronic conditions. The aim of our study was to validate "Good2Go," the first French-language transition readiness questionnaire. We analyzed the data from 2 multicentric studies (Canada and France) involving adolescents with chronic conditions (type 1 diabetes, inflammatory bowel disease, cystic fibrosis, epilepsy, juvenile idiopathic arthritis). Content and construct validity were examined using factorial and Rasch analysis (structural validity), Spearman's correlation, and Mann-Whitney test (external validity). Cronbach's α and intra-class correlation coefficients explored reliability. Cognitive interviews assessed wording comprehension and item appropriateness. Good2Go was completed by 321 participants (boys = 51%; mean age = 16.4 years (standard deviation = 1.5; min = 14.0; max = 18.0); Canada = 51.1%). Factor analysis identified 3 domains: "health self-advocacy," "knowledge about chronic conditions," and "self-management skills." The 3-domain structure showed a satisfying Rasch fit, internal consistency, and test-retest reliability. Good2Go domain scores were significantly higher in participants over 17 years of age, indicating satisfactory external validity.Conclusion: Good2Go is a valid 20-item questionnaire to assess transition readiness in adolescents with chronic conditions and may be useful in routine care to propose individually tailored preparation for their transfer to adult healthcare. Further research is now needed to analyze correlation between domain scores and success of transition.What is Known:• In adolescents with chronic conditions, the use of transition readiness questionnaires is recommended to propose individually tailored preparation for their transfer to adult healthcare.• However, no French-language questionnaire has been so far validated.What is New:• Based on a complete validation methodology, this study highlights that the French-language 20-items Good2Go questionnaire has good psychometric properties.• It explores all transition key points though 3 scored domains: "health self-advocacy", "knowledge about chronic disease" and "self-management skills".

Practical generic guidelines for paediatric-to-adult transition for adolescents with chronic disease.

BACKGROUND: The last 20 years have seen many attempts to improve transition to adult healthcare for adolescents with chronic disease, but there is currently no established consensus on generic practices. Our goal was to identify relevant and pragmatic guidelines for transition practice for each step of this process (before, during and after transfer), applicable to a wide range of chronic illnesses and health services, via a participatory approach involving all the key stakeholders. METHODS: We conducted interviews and a literature review to elaborate a questionnaire for use in an online 2-round Delphi survey. The survey panel included 36 French health and social professionals from different care settings, and young adults and parents with an experience of healthcare transition related to all types of chronic disease. RESULTS: The survey consensus identified 19 items on feasibility and relevance criteria, which form the guidelines. It is composed of five practices to be adopted during preparation in paediatrics, seven practices in the active phase of transition and seven in adult care. Two guidelines achieved complete consensus: having a longer consultation for the first appointment with the adult doctor, and keeping the same adult doctor throughout follow-up. A further 36 items met the criterion of relevance, but were deemed unfeasible. CONCLUSIONS: Taking into account all stakeholder views and the real-world applicability of care practices enabled us to elaborate consensual guidelines whose implementation requires no additional health service resources.

[Living with diabetes during adolescence]. / Vivre avec un diabète à l'adolescence.

Teenagers undergo a period of rapid transformations, on a physical, psychological and social level. Diabetes, at this age, risks undermining these processes due to the constraints of the treatment and the teenagers' increased dependence, notably on their parents. The nursing teams need to be vigilant in helping the teenager and their parents overcome these obstacles, while preserving their future through proper control of the diabetes.

Clinics dedicated to transition preparation for adolescents and young adults with chronic conditions: Factors influencing their use.

To pool resources and reduce inequalities in access to transition preparation for patients, transition clinics were created in France. They are places in hospitals, independent of the usual care departments, offering multiple resources and services for adolescents and their parents. Of the 24 physicians from care departments who were surveyed, half of them do not use transition clinics. The implementation of transition clinics in hospitals did not lead to their adoption by the care departments that needed the most support for transition preparation of their patients. A strategy improving adoption is needed to allow transition clinics to reduce inequalities.

[Supporting the adolescents with chronic condition during transition: Role of the transition units]. / Accompagner la transition des jeunes avec une maladie chronique - Rôle des plateformes.

The transition of care between pediatric and adult care is a key-period for adolescents with chronic disease, because of the high risk of follow-up loss and of short-term and long-term poorer health. To support transition, platforms of transition have been created in France since several years, implemented in pediatric or adult care structures. Their common objective is to provide a physical reception of adolescents and their parents to share about transition issues, and to inform them about resources to enhance the adolescent's global health. They tend to work closely with the referent health care providers and the patients' associations. A large heterogeneity of functioning and health care supply is still observed in these recent structures. Supporting these structures and reinforcing the partnerships between pediatric and adults care remain a challenge.

TITLE: Accompagner la transition des jeunes avec une maladie chronique - Rôle des plateformes. ABSTRACT: La transition entre la pédiatrie et la médecine pour adultes est une période charnière pour les adolescents et jeunes adultes porteurs d'une maladie chronique : elle comporte un fort risque de rupture du parcours de soins et de dégradation de l'état de santé à court et long termes. Pour accompagner ce passage, plusieurs plateformes de transition ont été créées ces dernières années en France, dans des hôpitaux pédiatriques ou dans les hôpitaux pour adultes. Leur objectif commun est d'être un lieu ressource offrant un accueil physique des jeunes et de leurs parents autour des questions liées à cette transition, ainsi qu'un accès aux informations utiles à leurs besoins de santé globale. Elles travaillent en partenariat étroit avec les services de soins et les associations de patients. Une forte hétérogénéité de fonctionnement et d'offre de soins est observée dans ces structures encore récentes, qu'il convient de multiplier et de pérenniser. Le principal défi à relever dans les prochaines années est de renforcer les partenariats entre pédiatrie et hôpitaux pour adultes afin de baliser au mieux le parcours de soin des jeunes porteurs d'une maladie chronique.

[Managing the transition from childhood to adulthood in people with chronic disease]. / Gestion de la transition enfance-âge adulte dans les maladies chroniques

Managing the transition from childhood to adulthood in people with chronic disease. In young people with chronic condition, the transition from childhood to adulthood is a double challenge: challenge of adolescent development, impaired by disease or disability, and challenge of transition from pediatric to adult healthcare. To avoid discontinuity of care, transition must begin early (12-13 years) around personalized objectives, and be supported until transfer in adult care, planed when the adolescent is ready and clinically stable. In a perspective of empowerment, education of the young patient includes the self-management of the disease but also of its impact on life in young adults (affective aspects, professional life, hobbies, general health…). Attention should be paid on coordination between pediatric and adult care.

Gestion de la transition enfance-âge adulte dans les maladies chroniques. Pour les jeunes atteints de maladie chronique, le passage de l'enfance à l'âge adulte représente un double défi : défi du développement adolescent, impacté par la maladie ou le handicap, et défi du passage des services de pédiatrie aux services d'adultes. Pour limiter les ruptures de suivi, la transition se prépare précocement (12-13 ans) autour d'objectifs personnalisés, et s'accompagne jusqu'au transfert en soins d'adultes, programmé quand le jeune est apte et cliniquement stable. Dans une démarche d'autonomisation, éduquer le jeune patient implique d'aborder avec lui l'autogestion de sa maladie mais aussi son impact sur sa vie de jeune adulte (vie affective et professionnelle, loisirs, santé générale…). Coordonner les soins avec l'équipe d'adultes est aussi un point-clé.

High Prevalence of Polycystic Ovary Syndrome in Type 1 Diabetes Mellitus Adolescents: Is There a Difference Depending on the NIH and Rotterdam Criteria?

BACKGROUND: Polycystic ovary syndrome (PCOS) is more frequently observed in type 1 diabetes mellitus (T1DM) adult women than in nondiabetic women. No such prevalence has yet been studied in adolescent girls with T1DM. AIM: The aim of this study was to evaluate the prevalence of PCOS in adolescent girls with T1DM and to determine the clinical and hormonal features associated with the disorder. METHODS: A cross-sectional study of 53 adolescent girls (gynecological age >2 years) referred for routine evaluation for T1DM was conducted. We diagnosed PCOS using the National Institutes of Health (NIH) and Rotterdam criteria. RESULTS: 26.4 and 47.9% of adolescents had PCOS according to NIH (NIH-PCOS) and Rotterdam (Rotterdam-PCOS) criteria. 66.7% of NIH-PCOS adolescents had a complete phenotype associated with hyperandrogenism, oligomenorrhea, and polycystic ovarian morphology, unlike only 33.3% of the Rotterdam-PCOS adolescents. A family history of type 2 diabetes mellitus (T2DM) was more frequent in PCOS than in non-PCOS girls, whichever criteria were used. Late pubertal development and a T1DM diagnosis close to puberty were factors associated with NIH-PCOS. CONCLUSION: Adolescents with T1DM had a high prevalence of PCOS. More differences between PCOS and non-PCOS patients were found using the NIH criteria, suggesting that clinical characteristics might be more accurate for diagnosing PCOS in girls with T1DM. A family history of T2DM is associated with a high risk of PCOS.

[Self-cutting in adolescents: when to worry?]. / Les scarifications chez l'adolescent : quand s'inquiéter ?

Self-cutting in adolescents: when to worry?. Self-cutting, the most part of the nonsuicidal self-harming behaviours, seems becoming quite common among adolescents. Nevertheless, assessment and follow up are always required with at least three aims: to assess globally the adolescent' situation, and his or her to psychological distress - to look for a passed trauma (i.e sexual abuse) behind the self- harm behaviour - to recognize psychiatric disorders beside self-harming and to recognize patients to refer to the mental health services.

Les scarifications chez l'adolescent : quand s'inquiéter ?. Les scarifications semblent aujourd'hui devenues banales chez l'adolescent. Elles doivent cependant toujours susciter une inquiétude médicale et conduire à une évaluation globale et à une proposition de suivi, en raison du mal-être dont elles témoignent et des éventuels antécédents traumatiques (par exemple des abus sexuels) qu'elles peuvent révéler. Cette évaluation permet également d'identifier les situations plus rares dans lesquelles les scarifications ne sont qu'un élément de troubles psychiatriques plus graves nécessitant d'emblée une expertise et une prise en charge en santé mentale.

High prevalence of hirsutism and menstrual disorders in obese adolescent girls and adolescent girls with type 1 diabetes mellitus despite different hormonal profiles.

OBJECTIVES: To compare the pubertal development, the hormonal profiles and the prevalence of hirsutism and menstrual disorders in obese adolescent girls and adolescent girls with type 1 diabetes mellitus (T1DM). METHODS: Data were collected from 96 obese adolescent girls and 78 adolescent girls with T1DM at Tanner stage IV or V, whose ages ranged between 11.9 and 17.9 years. RESULTS: High prevalence of hirsutism and menstrual disorder was found in the obese adolescent girls (36.5 and 42% respectively) and the adolescent girls with T1DM (21 and 44% respectively). The obese girls were significantly younger at pubarche, thelarche and menarche than the girls with T1DM. Hirsutism in the obese girls and those with T1DM was associated with hyperandrogenaemia and a raised free androgen index (FAI). When the cause of the raised FAI was investigated in both the groups of girls with hirsutism, the raised FAI in the obese girls was due to low serum sex hormone-binding globulin (SHBG) levels. In contrast, the raised FAI of the girls with T1DM and hirsutism was due to hyperandrogenaemia. Menstrual disorders in the T1DM girls were associated also with hyperandrogenaemia unlike obese girls. CONCLUSIONS: Hirsutism and menstrual disorders are common in obese adolescent girls and adolescent girls with T1DM. Although hyperandrogenaemia is present in both groups of girls, the androgenic profiles of the two groups differ. The hyperandrogenaemia in the obese girls is primarily due to their decreased serum SHBG levels, whereas the hyperandrogenaemia in the girls with T1DM is due to their increased androgen production.